Uric Acid, Ferritin, Albumin, Parathyroid Hormone and Gamma-Glutamyl Transferase Concentrations are Associated with Uremic Cardiomyopathy Characteristics in Non-Dialysis and Dialysis Chronic Kidney Disease Patients

Abstract

Introduction Circulating uric acid, ferritin, albumin, intact parathyroid hormone and gamma-glutamyl transferase each participate in biochemical reactions that reduce or/and enhance oxidative stress, which is considered the final common pathway through which pathophysiological mechanisms cause uremic cardiomyopathy. We hypothesized that the respective biomarkers may be involved in the development of uremic cardiomyopathy characteristics and can be useful in their identification among chronic kidney disease patients. Methods We assessed traditional and non-traditional cardiovascular risk factors including biomarker concentrations and determined central systolic blood pressure using SphygmoCor software and cardiac structure and function by echocardiography in 109 (64 non-dialysis and 45 dialysis) patients. Associations were evaluated in multivariate regression models and receiver operator characteristic (ROC) curve analysis. Results Each biomarker concentration was associated with left ventricular mass beyond stroke work and/or inappropriate left ventricular mass in all, non-dialysis and/or dialysis patients. Ferritin, albumin and gamma-glutamyl transferase levels were additionally associated with E/e’ in all, non-dialysis and/or dialysis patients. Dialysis status influenced the relationship of uric acid concentrations with inappropriate left ventricular mass and those of gamma-glutamyl transferase levels with left ventricular mass and inappropriate left ventricular mass. In stratified analysis, low uric acid levels were related to inappropriate left ventricular mass in dialysis but not non-dialysis patients (interaction p=0.001) whereas gamma-glutamyl transferase concentrations were associated with left ventricular mass and inappropriate left ventricular mass in non-dialysis but not dialysis patients (interaction p=0.020 to 0.036). In ROC curve analysis, uric acid (area under the curve (AUC)=0.877), ferritin (AUC=0.703) and albumin (AUC=0.728) concentrations effectively discriminated between dialysis patients with and without inappropriate left ventricular hypertrophy, left ventricular hypertrophy, and increased E/e,’ respectively. Conclusion Uric acid, ferritin, albumin, parathyroid hormone and gamma-glutamyl transferase were associated with uremic cardiomyopathy characteristics and could be useful in their identification. Our findings merit validation in future longitudinal studies.

Identification of Cell-Cell Communications by Single-Cell RNA Sequencing in End Stage Renal Disease Provides New Insights into Immune Cell Heterogeneity

“…Ferritin has been identified as a biomarker of iron overload, inflammation, and malignancy and is thus associated with uremic cardiomyopathy and elevated all-cause mortality. 19 , 20 Other researchers demonstrated that decreased Bcl-2 expression and resistance to B-cell-activating factors in patients on HD contributed to the apoptosis of B cells and the inhibition of B-cell proliferation, leading to the global suppression of humoral immunity. 21 Another important finding in our study was the imbalance of B cells/Treg cells in patients with ESRD, indicating that humoral immunity was also dysregulated due to the dysfunction of immune suppression maintained by Treg cells.…”

The relative potential contribution of volume load and vascular mechanisms to hypertension in non-dialysis and dialysis chronic kidney disease patients

“…Each patient provided informed written consent prior to participation. The study design was reported previously ( 28 – 30 ). One hundred and fifteen patients participated.…”

“…Methods that were employed in this study have been reported previously ( 28 – 30 ). Recorded baseline characteristics comprised demographic features, anthropometric measures, major traditional cardiovascular risk factors, non-traditional or renal cardiovascular risk factors and the use of cardiovascular drugs and erythropoietin stimulating agents.…”

“…Echocardiography was performed in accordance with the American Society of Echocardiography convention ( 35 ) and employing a Philips CX50 POC Compact CompactXtreme Ultrasound System [Philips Medical Systems (Pty) Ltd, USA] equipped with a 1.8–4.2 MHz probe that allowed for M-mode, 2-D and tissue Doppler measurements, as previously described ( 30 ). Patients were examined in the partial left decubitus position.…”

Associations of Traditionally Determined Left Ventricular Mass Indices and Hemodynamic and Non-Hemodynamic Components of Cardiac Remodeling with Diastolic and Systolic Function in Patients with Chronic Kidney Disease

“…We previously reported the applied methods were previously reported in another study [ 27 , 28 , 29 ]. Recorded baseline characteristics included demographic features, anthropometric measures, major traditional cardiovascular risk factors, non-traditional or renal cardiovascular risk factors, the use of cardiovascular drugs and erythropoietin stimulating agents and established cardiovascular disease.…”